A Prospective Evaluation of the Influence of an Electronic Clinical Practice Guidelines on Concussion Patients’ Future Activities and Outcomes

Publication date: June 2018
Source:The Journal of Emergency Medicine, Volume 54, Issue 6
Author(s): Brian H. Rowe, Leeor Eliyahu, Justin Lowes, Lindsay A. Gaudet, Jeremy Beach, Martin Mrazik, Garnet Cummings, Donald Voaklander
BackgroundPatients with mild traumatic brain injury or concussion commonly present to the emergency department for assessment; providing patients with information on usual symptoms and their progression may encourage faster recovery.ObjectivesThis study aimed to document the role of an electronic clinical practice guideline (eCPG) patient handout on concussion recovery in adult patients discharged from the hospital.MethodsA prospective cohort study was carried out in 3 Canadian urban emergency departments. Adults (≥17 years of age) with a Glasgow Coma Scale score of 13 to 15 who sustained a concussion were recruited by on-site research assistants. Physician use of a concussion-specific eCPG was documented from physician and patient reports. Patient follow-up calls at 30 and 90 days documented return to work/school activities and patient symptoms. Multivariate analyses were performed using logistic regression methods.ResultsOverall, 250 patients were enrolled; the median age was 35 (interquartile range 23–49) and 52% were female. Approximately half (n = 119, 48%) of patients received the eCPG handout, and return to work/school recommendations varied. Symptoms persisted in 60% of patients at 30 days; patients in the eCPG group had fewer symptoms (odds ratio 0.57, 95% confidence interval 0.33–0.99). At 90 days, 40% of patients reported persistent symptoms, with no significant difference between groups.ConclusionAn eCPG handout improved patients' short-term outcomes; however, physician use and adherence to guideline recommendations was low. To further facilitate physician compliance and therefore patient recovery, barriers to use of the eCPG handout need to be identified and addressed.



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